At 12:24 06/02/03 -0500, Ed Weick wrote: (KH) > What you say can't be so because public services would have extinguished > private health services long ago. (Presumably, you still have private > health services in Canada?) (EW) <<<< It's a publicly operated system, though, as I understand it, the clinics that doctors and various technicians operate out of are usually privately owned. Transfers from the federal government to the provinces, mandatory services, fees chargeable, etc., are determined under the Canada Health Act, a federal statute. All provinces and territories provide a range of health services that go beyond the requirements of the Canada Health Act. These include programs such as pharmacare, home care, ambulance services, and aids to independent living. They are provided at provincial and territorial discretion, and on their own terms and conditions. Major hospitals are operated by the provinces.
There is no privately operated, for profit, health system parrellel to the public system in Canada, though whether there should be one has been a matter of some debate. The Royal Commission on Health Services recommended against it. >>>> Interesting. It seems, though, that you have some sort of hybrid scheme whereby doctors and technicians can charge rents which satisfy them. Our National Health Serive is also a hybrid service whereby consultants are paid a good salary by the NHS for a small number of hours of work every week (20 or so, I think) but can also carry on private practice (thus earning a great deal more). Of course, the biggest evil in our public health service is that there's a restrictive practice in the training and supply of doctors by the British Medical Assosication. (I believe there is a similar problem in the US.) Since the beginning of the NHS this has meant that doctors and consultants have been able to hold the NHS to ransom every time there was some problem. (KH) > No, I'm afraid you can't prove the case with the occasional Commission. > They can be cooked-up to prove anything that the government or the civil > service wants to hear. What should be looked at are the general trends -- > and across several countries. This is what MacRae was writing about. Public > services in several fields -- and health and education most noticeably -- > are now deteriorating in almost all developed countries despite, as in > England, much greater expenditures. (EW) <<<< The Commission I refered to, the Royal Commission on Health Services, was totally independent of government and took several years to do its work. It was not just an "occasional Commission". I don't think it arrived at its conclusions lightly. It researched health services in other countries, including the US and probably the UK. However, I would admit that it may have had a bias toward public systems because its chair was a former Premier of Saskatchewan, the cradle of Canada's public health system. >>>> I'm sorry, but Commissions appointed by governments (advised by civil servants) can never be guaranteed to be independent. Some may turn out to be, but many more (at least in our experience) are likely not to be because there are too many potential honours and rewards available for those who take part. At the very least, there should be no ex-politicians or retired civil servants involved. A Commission is more likely to be independent if its members come from a quite different career stream -- such as academia or business. (EW) <<<< With regard to education, it's rather remarkable that the public system here in Ontario is still holding up quite well despite underfunding (one can only wish for the "much greater expenditures" you refer to!). Mainstream courses -- mathematics, sciences, the arts -- are still being taught at a high level of quality. However, services catering to kids with special needs have been cut back. At my daughter's high school, there have also been cuts in janitorial services, so the Principal has had student volunteers help keep the school tidy as part of their required 40 hours of community service. >>>> Well, I'm pleased for the sake of Canadian children that your educational service is holding together better than ours. I've often used dramatic language in describing ours (and our health service) as heading for disaster. I don't take this back -- both *are* heading for disaster -- but in our case it is not so much the public ownership that is the main problem but the bureaucratic distance between the customer and the highly centralised nature of the control established by London plus the protective practices exercised by the unions involved (the teacher unions, or the British Medical Assoication in the case of health). The result is that both teachers and general practitioners (in contrast to hospital consultants) are underpaid, overstressed and, as a result, we have a shortage of tens of thousands of both which is getting worse every year despite enormous recruitment of replacements (usually from developing countries which are thus deprived of their best people). Sooner or later, both our state education and health services will collapse or, more likely, will have to be broken up (on which the present Labour government is now making a start in both cases). Both services have had large sums of money thrown at them in recent years with scarcely any improvement. For example, the NHS has received 40% extra funding in the last six years but most of it has disappeared into a black hole with a smaller number of doctors and nurses than before. Even the Health Department has acknowledge that the number of patients dealt with has improved only by 1.5 %. Considering that public services in other European countries and also America, much more highly decentralised than England, are all suffering from very similar problems of demoralisation and deteriorating standards suggests that public services are on the decline in all developed countries. Maybe the highly dispersed nature of your population centres means that Canada's public services are able to remain focussed on customer needs rather than on distant diktat and, because of this is not deteriorating as fast as ours are, but I suggest that it's only a matter of time. Keith ---------------------------------------------------------------------------- ------------ Keith Hudson, General Editor, Handlo Music, http://www.handlo.com 6 Upper Camden Place, Bath BA1 5HX, England Tel: +44 1225 312622; Fax: +44 1225 447727; mailto:[EMAIL PROTECTED] ________________________________________________________________________ _______________________________________________ Futurework mailing list [EMAIL PROTECTED] http://scribe.uwaterloo.ca/mailman/listinfo/futurework
